Bunion- Bennet

Question 1

hallus abducto valgus and associated complications

Answer 1

prominent metatarsal head
*hypermobility of the 1st ray ( usually insufficient)
* callus
hammer toe on 2nd digit
*rearfoot valgus deformity
gait evaluation- overpronation
arch collapse (VERY MUCH SO) {the peroneus longus tendon is stretched with collapsed arch. }
*1st MTPJ: 60 degree ROM, 45/15 ( should be under 25 and 15)
may also see ingrown nail.

Question 2

conservative treatment options

Answer 2

initial: ibuprofen 600mg (NSAIDS). patient cases for orthotics to help with arch. follow up in a month. 
shoe modifications ( new balance/asics).

Question 3

non conservative treatment options

Answer 3

surgery: 
lapidus procedure ( fusion), appy hardware
make sure the joint is aligned
remove promience on the medial side. 
level 3- ( HA >35, IA>25)
CTB: capsule tendon balance
exostectomy
osteotomy
resection arthroplasty
MTP/MC arthrodeis

Question 4

indications for surgical intervention?

Answer 4

after conservative options are no longer providing substantial relief or no improvement. pain not tolerable and affecting the ability to pursue activity. so when it is more limiting like this… time to do surgery.

Question 5

what is track bound mean?

Answer 5

the joint cannot move…? not too sure, term Bennet used. someone let me know :)

Question 6

what is HA and IA?

Answer 6

Hallux abductus angle ( n=20 or under)
interphalangeal angle ( n=10 or under)
these angles may progress and are indicative of severity. greater the angle, greater the classification stage of severity.

Question 7

what did the orthotic provide?

Answer 7

picks up arch. controls motion of the calcaneos which has a peroneus longus tendon that is stretched

Question 8

Tell me more about the IM angle?

Answer 8

bisection of the first and second metatarsal.

15-16 degrees = mild to moderate

Question 9

tell me more about HA angle?

Answer 9

bisection of the proximal phalnyx and proximal metatarsal. usually greater than 20 degrees has pathology.

Question 10

what should be considered when looking at the MTPJ joint?

Answer 10

are there arthritic changes
deviation, subluxed, or congruent
are the sesmoids in the right place?

Question 11

what are some soft tissue observations to make?

Answer 11

adductor tendon ( lateral portion of 1st MPJ) this contributes to bunion. sometimes you can transfer this. medial portion of the joint can be lengthened ( lateral was shortened)
this might require a CTB: capsule tendon balance. or a capsuloectomy on the lateral side. 
small wedge of tissue taken out of medial tissue allows for foot to be in a more rectus position.

Question 12

evidence based medicine… surgical outcomes.

Answer 12

long term outcomes of lapidus procedure: READ ARTICLE
graph: MID = minimal importance difference highlighted that those who received surgery had less foot pain, better function and general foot health after the surgical benefits were strong and allowed for long term health.